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rete run 217/2006 11:13:09AM SAN JO?^UIN COUNTY ENVIRONMENTAL HEAL'I DEPARTMENT Report#5021 <br /> Pagel <br /> Run by 4006 Facility Information as of 2/7/200D44 <br /> Record Selection Criteria: Facility ID FA0015988 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> IL OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012910 ..+ e-ae"—s"a New Owner ID <br /> Owner Name HALL, MATTHEW M <br /> Owner DBA <br /> Owner Address 2029 CHEROKEE RD# B <br /> STOCKTON, CA 95205 <br /> Home Phone 209-948-1800 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2029 CHEROKEE RD# B <br /> STOCKTON, CA 95205 <br /> Care of CENTRAL VALLEY TRANSMISSION <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015988 _ _ _ /—f�✓�� <br /> Facility Name CENTRAL VALLEY TRANSMISSION <br /> Location 2029 CHEROKEE RD#B <br /> STOCKTON, CA 95205 <br /> Phone 209-948-1800 <br /> Mailing Address 2029 CHEROKEE RD#B <br /> STOCKTON, CA 95205 <br /> Care of HALL, MATTHEW <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027882 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CENTRAL VALLEY TRANSMISSION (Circle One) <br /> Account Balance as of 2/7/2006: $74.00 <br /> (Circle One) <br /> Transfer o Activa/Inaclve <br /> Progmm/Element and Descriptor, Record ID Employee ID and Name Status New Owner? ele <br /> 2221 -USED OIL ONLY-<5 TONSNR PR0523698 EE0008373-JOHN JACKSON Active Y N A owner, 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges a 'aced h this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also canny that all operations will be performed in accordance with all applicable Ordinate Codes and/or Sta arils and <br /> State andlor Federal Laws. / <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: •$372.00= Amount Paid Date / / <br /> Payment Type Check Number Received b/� <br /> REHS: Date_/� Accountout _ _ (�l� Date P/ –7 / o L <br /> COMMENTS: - <br /> 2'1(0 <br /> 0� STw <br /> �1-5 /0 - � a tS ���� C(l CUc.eD <br /> / 014r a CS 5 A'TSl TC- � Lr/!-/J•�-irC � fA��� <br /> /OCs AAI y1 D�/ <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />